HomeMy WebLinkAbout1394 i~
Daclaration of Domicile and Citizenship
_1 '
TO THE STATE AND COUN1'Y TAX ASSESSOR, 'K'~'~
Sl. LUCIE COUNTY, FLORtDA:
This is my declaration of Domicile and Citizenship ~n the ~tate of Florida that I ar.i fi!ing this day in acco~dance and
in conformity with Chapter 222, 5eciinn 222.17, Flarida StatuteY. ~
I was formerly a~}g~~resident of AF~.~ j~y~;g- _ - _ _ - --fllSZll--------
(Ciry) (State)
and I resided at _635 It~e .x.il~~__~1b1`_~tQ___________ . However I havechanged my domiCi~e
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida sincP ~sd day of
____A1igtlSt . . 19~l.r1_, and I reside at 1,3Q$ ._$IItl#h -1~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
?+nd this statement is to be taken as my dec~aration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, s~~ch as safr. of property or business, or relinquishment of employment
at former domicile,- removal of family to new domicile, purchase ~f home, etc.)
. ~,C.~c.lsc-
~
,,;..:+~:~t;rr,,.:, FILED aN~ ~EC~R~ED
, . l~ ~ i : ~ - • • ~p~ ~ 0 ~ f~
' ~ . ~ ~4, ~"-71T+~.~
N ~
~ - /
~ , t ~ -
;=~":J= "j' : '65 al1G 23 Ah~ iC : I 3
: ;
~:N : _ y o-s
. . ~ Q' ~ -d-~`a~~rti..~~~`7
v - - -
. ~ ROGE.~ , . CL.~r~K
.
G~~.,.1~~ ST. LUC;~ COU~vTY.
,,E:t:; FLORIDA
f fURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTI~Y that I have no ~niention ta return to my former domiCile, and I iniend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIC~A, permariently.
1 _~..k _ ~ L.~..~ ~
_ ~ c.....L
1~~(~-----
~ ~ (Narne) d~
; 1308_South 13th_ Str~~t _ _
~ ~
(Address)
Sworn to and subscribed before me this _,`Z3LC1.__~ day of - ~U~u3~ 19~_S
RCIGER POItlt~?S ~ -
CLER IRCUIT COURT ~ Notary Public
, ~;,E
gy ~iMG~~ f,~. My Commission expires
(To bs ~xecuPed in duplicale ai~d origit?a1 ~tled ~wirh Clerk~C~rc , snd d ~ with~Tax Assaswr.)
~ ~ ~ ~U~JI~ .